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Slipping rib syndrome

From Physiopedia


Slipping rib syndrome


Slipping rib syndrome is a condition, often mis –or underdiagnosed and can consequently cause months and even years of unresolved abdominal and/or thoracic pain[1]. In one review they stated that in the 76 cases that they’d reviewed, in none of the patients the diagnosis had been considered by the referring doctor and many patients had been subjected to extensive investigations[2]!
Clinical presentation:
The painful rib syndrome is presents itself by three features[2]:
• pain in the lower chest or upper abdomen
• a tender spot on the costal margin
• reproduction of the pain by pressing the tender spot.


Two tests for investigating Slipping rib syndrome are the Hook maneuver[3] , in this test the patient lies on his unaffected side, while the therapist hooks their fingers under the lower costal margin and pulls anteriorly. A positive test reproduces the patient’s pain and causes a click. Another test described is looking for rib restriction by observing a lack of symmetry of the posterior chest wall movements on deep breathing.[4]

It’s impossible to make this diagnosis with radiologic investigation, but for differential diagnosis purposes, it may be useful


Management can include :[5]
• Reassurance of the benign nature of the disease combined with explanation and advice concerning postural avoidance
• Manual therapy: manipulation of the costovertebral joint can help manage the pain
• Local anaesthetic nerve blocks was proven useful in some cases (a supplementation of corticosteroids can be helpful)

At failure of this general management, removal of the anterior end of the rib and costal cartilage may be performed. This has many reports of successful outcomes, reported in the literature.


  1. Brian E Udermann. Slipping Rib Syndrome in a Collegiate Swimmer: A Case Report. J Athl Train. 2005 Apr–Jun; 40(2): 120–122. Level 3B
  2. 2.0 2.1 E M Scott and B B Scott. Painful rib syndrome--a review of 76 cases. Gut. 1993 July; 34(7): 1006–1008. Level 3A
  3. Heinz GJ, Zavala DC. Slipping rib syndrome. JAMA1977; 237(8): 794-5
  4. DeLisi N. Slipping rib syndrome: ’there’s an easier way’. Geriatrics1995; 50 (7): 7 level 5
  5. Gregory P.L., BISWAS A.C., Batt M.E.,Musculoskeletal problems of the chest wall in athletes, Sports Med., 2002;32(4):235-50. Level 3A

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